IC27 HEALTH INSURANCE EXAM – 11

Q1.Under ‘human interface/process improvisation’, what are the measures for fraud prevention
 

 Creation of fraud database

 

 Ease of data capture

 

 Extract data output in a desirable format

 

 Comprehensive claims information

 

 Ability to detect fraud effectively

 

Q2.Which type of fraud occurs when people deliberately provide wrong information with regard to the pre-existing illness to influence the underwriting process in the favour of the applicant.
 

 Underwriting fraud

 

 Hard fraud

 

 Soft fraud

 

 Internal fraud

 

 External fraud

 

Q3.__ report sometimes also depends upon the amount of cover opted
 

 Financial documents

 

 Sales

 

 Proposal form

 

Actuarial

 

 Medical

 

Q4.In which year was the Malhotra Committee formed?
 

 1990

 

 1991

 

 1992

 

 1993

 

 1994

 

Q5.____ analysis shows the average amount and the percentage of the total amount paid.
 

Claims analysis by age bands

 

 Earned premium

 

 Earned premium

 

 Group size distribution

 

 Claims analysis by sum insured

 

Q6.___ is one of the measures under technology and process interface for fraud prevention.
 

 Creating fraud database

 

 Creating consumer awareness

 

 Fraud management philosophy and policy

 

 Effective legislation and judicial action

 

 Ease of data capture

 

Q7.__ is not a type of Claims Fraud.
 

 False claims

 

 Collusion with TPAs

 

 Insurance speculation

 

 Fraud rings

 

 Collusion with providers

 

Q8.___ looks after functions like sales, claims intimation, underwriting in case of Social Reinsurance.
 

Social Service Department of the Local Government

 

 NGO

 

 Insurance agency

 

 Healthcare provider

 

 Insurance agency

 

Q 9.What should be explained to the customer so that the claim process can become smooth and hassle-free with minimum dissonance?
 

 Company philosophy

 

Riders and covered expenses/events

 

 Terms and condition

 

 Comparison with competitor products

 

 Policy tenure

 

Q10.Which of the below statement(s) is/are correct with respect to IRDA’s role? 1. IRDA has specified several regulations for non-life insurance companies in many aspects of business 2. IRDA is very crucial in preventing adverse consequences of the health insurance for the cost of care, consumer satisfaction, fraud, and ethical standards, etc. 3. IRDA is not just a regulatory authority but also plays an active ‘development’ role in health insurance
 

 Only 1

 

 Only 2

 

 Only 3

 

 Both 1 and 3

 

 Both 2 and 3

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